RESUMO
PIP: Lessons learned from Haiti's integration of a training program for traditional birth attendants with the maternal and child health and family planning program are reported. The available data on illness and deaths reveal that Haiti has continuing problems of gastroenteritis, malnutrition, tuberculosis, malaria, and tetanus. The latter is of particular interest since neonatal tetanus derived from umbilical cord contamination continues to affect up to 10-20% of Haitian newborns in rural areas lacking health programs. Neonatal tetanus has largely disappeared in the Artibonite Valley due to a mass immunization program for the entire population, including young women, against tetanus. In the Albert Schweitzer Hospital program for indigenous midwives in Artibonite Valley, at least 36 midwives were reached on a regular basis in 1968 -- less than 1/3 of the midwives operating in the Artibonite Valley. There was a rapid decline in neonatal tetanus admissions during the period following 1968. This decline has been attributed to the use of rural health auxiliaries in immunizing the women in the hospital district, but indigenous midwives may have played a role. By 1970, the Albert Schweitzer Hospital program had grown from 36 midwives regularly attending midwife classes to 175 registered with the program during 1970. Although direct supervision proved difficult due to lack of communication and transport to the scene of delivery, some deliveries were observed and indirect supervision by the community became evident. An important finding of the traditional midwife training program of the Albert Schweitzer Hospital was the amount of time required for an indigenous midwife to have referred 50 newborns to the hospital for BCG vaccination. At the end of the 1st year of this program, only 2 midwives reached this goal. Another surprise was the increase in demand for "cord cut" services at the outpatient clinic rather than increased use of the nearby maternity unit. The elimination of neonatal tetanus as a cause of infant mortality was the most important outcome of the maternal and child health component of the community health program.^ieng
Assuntos
Mortalidade Infantil , Tocologia , Tétano/prevenção & controle , Haiti , Humanos , Imunização , Lactente , Mortalidade Materna , População Rural , Tétano/mortalidadeRESUMO
This paper presents data from an experimental project which distributed oral contraceptives, foam, and condoms to households in three rural areas of Haiti between January 1978 and March 1980. The contraceptive distribution had little apparent impact on traditional, prolonged breastfeeding patterns, and the percentage of women pregnant after eight months of field operations declined over 35 per cent in the two areas where contraceptive acceptance and use were highest. (Am J Public Health 1982; 72:825-838.)